KRITERIA DIAGNOSTIK

FETAL DISTRESS
 Clinical diagnosis of fetal distress (Acute fetal distress)
 Electronic fetal heart rate monitoring.
 Fetal movement (frequently decreases and weakens).
 Diagnosis of fetal Acidosis by FBS (fetal scalp blood sample)
 CTG (Cardiotomography)
 The clinical diagnosis of fetal distress is accurate in 29.1% of the cases.
However, it has led to an unnecessary caesarean section in the remaining
70.9% of the parturients. In order to reduce this high trend of unnecessary
caesarean sections due to clinical diagnosis of fetal distress in this
environment, antepartum fetal assessment with non-stress test or
biophysical profile and intrapartum use of continuous electronic fetal
monitoring should be used to confirm or refute the fetal distress before any
surgical intervention. Fetal blood sampling and fetal pulse oximetry should
be performed in event of non- re-assuring or abnormal cardiotocography.

Evaluation of Clinical Diagnosis of Fetal Distress and Perinatal Outcome in a Low Resource Nigerian Setting
Biophysical Profile

 The biophysical profile (BPP) combines the use of CTG with the ultrasound
assessment of fetal movement, fetal tone, fetal breathing movements,
and amniotic fluid volume. Each parameter is scored 0 (abnormal) or 2
(normal) points, with a maximum total score of 10

 ≥8 >>>>>> REASSURING (LOW STILLBIRTH RATE)

 <6 >>>>>> NOT REASSURING (BORDERLINE)
Amniotic Fluid Evaluation

 Amniotic fluid volume is an important parameter for the assessment of fetal

well-being. It is a reflection of placental perfusion and normal fetal blood
flow from the placenta and may be decreased when there are factors
causing growth restriction (Chauhan et al. 2007).

 During the third trimester, normal amniotic fluid correlates with an AFI of
10–20 cm. Borderline values are 5–10 cm for decreased fluid and 20–24 cm
for increased fluid depths (Hebbar et al. 2015).

 perinatal mortality in pregnancies with oligohydramnios is 50 times higher

than in pregnancies with normal AFI (Ott 2005; Morris et al. 2014).
Amnioscopy

 At term, it is possible to visualize the amniotic fluid color using amnioscopy .

If it is clear, the liquor is considered normal; if it is colored, there is a
possibility of fetal distress because during fetal hypoxia there is an increase
in fetal intestinal peristalsis with the release of meconium from the fetal
rectum
Cardiotocography

 Cardiotocography (CTG) is the recording (-graphy) of the fetal

heartbeat (cardio-) and the uterine contractions (-toco-).
 Category I FHR tracings are normal tracings which are not
associated with fetal asphyxia.
 Category II FHR tracings are indeterminate and include a wide
variety of possible tracings that do not fit in either Category I or
Category III.
 Category III FHR tracings are abnormal and indicative of
hypoxic risk to the fetus and possible acidemia
Non Stress Test

 The purpose of NTS is to try to identify potential fetal compromise as a result

of placental insufficiency and hypoxia and to take corrective action.
 The test is more frequently done between 38 and 42 weeks’ gestation;
however, it can be used as early as the beginning of the third trimester.
 A normal test is defined as a “reactive” pattern that requires a minimum of
two accelerations (15 bpm increase from the baseline during 15 s) during a
20 min test.
 A “nonreactive” result suggests the possibility of fetal distress, requiring
further assessment (biophysical profile, a stress test).
The Contraction Stress Test

 The contraction stress test may be used after a nonreactive NST. This test
monitors the response of fetal heart rate to uterine contractions.
 “POSITIVE” if there are regular late decelerations (sign that the placenta
may not be delivering adequate amounts of oxygen to the fetus >>
SHOULD BE DELIVERED
 “NEGATIVE” When no late decelerations occur
Doppler Examination of Fetal and
Placental Circulation

 Doppler studies of fetal organs are used to detect the hemodynamic

rearrangements that occur in response to fetal hypoxemia, in particular by
insonnation of the middle cerebral arteries (MCA) and ductus venosus
(DV).
DURING LABOR
SURVEILLANCE
Monitoring of Fetal Heart Rate

 The pattern of the fetal heartbeat during labor is often a good indicator of
fetal well-being. The normal fetal heart rate (FHR) is 120–160 bpm.
 The typical fetal heart rate pattern is to slow somewhat during a
contraction and increase again at the end of a contraction.
Pulse Oximetry

 Fetal oxygen saturation decreases between the first and the second
stages of labor (from 60 % to 53 %): a value of 30 % is considered
pathological. A fetal oxygen saturation of 30 % for 10 min is associated with
acidosis and a poor fetal outcome. Low values of fetal oxygen saturation
are associated with an abnormal CTG trace
Fetal Scalp Blood Sampling

 A sample of blood from the fetal scalp may be tested during labor to
determine the acidity of the blood. This test is called fetal scalp blood
sampling (FSBS). If the fetus is not getting enough oxygen, the blood
becomes highly acidic.
Fetal Electrocardiography

 fetal acidemia is associated with fetal ECG ST-segment elevation and

increased T-wave amplitude.